Causes of brainstem hemorrhage

Written by Chen Yu Fei
Neurosurgery
Updated on June 18, 2025
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There are many reasons that cause brainstem hemorrhage. Clinically, it is mostly seen in patients with underlying diseases, such as hypertension, diabetes, and hyperlipidemia. Due to the lack of effective control and treatment of blood pressure, blood sugar, and blood lipids over a long period, severe arteriosclerotic changes and even arteriosclerotic plaques can develop. The blood vessels’ own regulatory functions gradually deteriorate. Under certain triggering factors, such as fatigue, exhaustion, and mental stress, blood pressure can transiently increase. When it exceeds the blood vessels' capacity to adjust, brainstem hemorrhage is likely to occur. Once brainstem hemorrhage occurs, the condition is often critical and requires immediate transportation of the patient to the nearest hospital for treatment.

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Written by Zhang Hui
Neurology
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Pre-symptoms of brainstem hemorrhage

Brainstem hemorrhage is extremely dangerous, and once a massive hemorrhage occurs, the patient can quickly lose consciousness and generally there are no effective emergency measures available. The patient will quickly die due to the involvement of the centers controlling heartbeat and breathing. The early symptoms of brainstem hemorrhage are not particularly obvious, but a careful medical history may reveal that patients often experience excessive fatigue, stress, emotional agitation, and poor sleep before the hemorrhage. Patients may show early signs such as dizziness, blurred vision, double vision, limb weakness, and slurred speech. If a patient has very high blood pressure and exhibits these early symptoms, especially if there is discomfort in the neck and upper back area, it is crucial to be highly vigilant and seek immediate medical attention. The prognosis for brainstem hemorrhage is very poor, thus it is essential to focus on preventive measures and properly control blood pressure.

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Written by Zhang Hui
Neurology
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How long does it take to wake up from a brainstem hemorrhage?

Brainstem hemorrhage is a very serious condition. If the amount of bleeding in the brainstem increases, the patient will rapidly become comatose and exhibit symptoms such as paralysis of the limbs, inability to swallow, and inability to speak. Generally, if a patient with brainstem hemorrhage falls into a coma and cranial CT confirms a large amount of bleeding in the brainstem, the chances of the patient waking up are very, very slim. If the amount of brainstem hemorrhage is not particularly large and the patient's level of coma is not very deep, treatment may lead to the patient waking up, which could take about two to four weeks. However, the prognosis for brainstem hemorrhage is generally poor, and if the patient falls into a coma, they are usually unlikely to wake up. The treatment for brainstem hemorrhage mainly involves controlling blood pressure and preventing complications. If respiratory failure occurs, timely treatment with a ventilator is necessary. Overall, brainstem hemorrhage has a poor prognosis and high costs.

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Written by Jiang Fang Shuai
Neurosurgery
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Can brainstem hemorrhage be operated on?

The brainstem is the center of human life, controlling vital functions such as breathing, circulation, heart rate, and blood pressure. Once bleeding occurs, patients often experience unstable vital signs, deep coma, and can die from brain function failure within a short period. Previously, it was believed that the brainstem was a no-go zone for surgery, and treatment for brainstem hemorrhage was primarily conservative medical therapy. However, with the continuous improvement of medical technology, neurosurgery departments in many top-tier hospitals have made significant achievements in minimally invasive or open surgeries for brainstem hemorrhages. Therefore, surgery for brainstem hemorrhage is not impossible and can be considered under specific circumstances.

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Written by Jiang Fang Shuai
Neurosurgery
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How long does one generally remain unconscious with brainstem hemorrhage?

The duration of coma following brainstem hemorrhage is uncertain. It mainly depends on two factors: The first factor is the amount of bleeding. For brainstem hemorrhages of less than three milliliters, the level of coma is relatively shallow, and some patients may not experience any coma at all, with a high chance of successful resuscitation. For hemorrhages greater than three milliliters, as the amount of bleeding increases, the depth of the patient's coma also deepens, potentially leading to death shortly after the onset of the condition, or the patient might remain comatose for a prolonged period before eventually succumbing. The second factor is whether timely and effective treatment was administered after the brainstem hemorrhage, including medication, necessary surgical interventions, active prevention of complications, and the stabilization of the condition, as well as treatments aimed at promoting awakening, among others.

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Written by Gao Yi Shen
Neurosurgery
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Symptoms and signs of brainstem hemorrhage

The symptoms and signs of brainstem hemorrhage must be judged based on the situation. There are many nerve fibers in the brainstem, and bleeding in any area could lead to different clinical manifestations. The most common general symptoms include headache, nausea, dizziness, vomiting, and numbness and weakness in the limbs, and even conditions such as drowsiness, stupor, and even coma may occur. If more severe, it could cause abnormal rhythms in heart and respiratory functions, and some special symptoms might appear. For example, hemorrhage in the midbrain might cause bilateral pupil constriction, especially pinpoint constriction; if the hemorrhage occurs in the medulla, it could cause respiratory and circulatory arrest early on.